Volume 33, Issue 126 (October 2020)                   IJN 2020, 33(126): 58-68 | Back to browse issues page

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Amini L, Shami M, Chegini R. The Relationship between Serum Levels of Oxidative Stress Biomarkers and Dysmenorrhea, Dyspareunia and Pelvic Pain in Women with Endometriosis. IJN 2020; 33 (126) :58-68
URL: http://ijn.iums.ac.ir/article-1-3308-en.html
1- Nursing Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
2- Sarem Fertility & Infertility Research Center, Iran University of Medical Sciences, Tehran, Iran (Corresponding author) Tel: +98214702 Email: m.shami@yahoo.com
3- Department of Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Abstract:   (2040 Views)
Background & Aims: Endometriosis is a common disorder associated with an increased risk of cancers, especially ovarian cancer. One of the most prevalent symptoms of this disease is pelvic pain, which is the major complaint among patients during menstruation. While the pathophysiology of endometriosis and the mechanisms responsible for its complications, namely pelvic pain and infertility, are not yet well understood, it seems that oxidative stress plays an undeniable role in the pathogenesis of endometriosis. In other words, the production of large amounts of inflammatory mediators by endometriosis tissue can explain and be responsible for the onset and exacerbation of pelvic pain. There is an apparent imbalance between oxygen free radicals and antioxidants in the endometrial tissue of diagnosed women. In addition, decreased total antioxidant capacity is observed in the peritoneal fluid in women with endometriosis, which is indicative of inadequate antioxidant status. Even though a significant relationship has been reported between symptoms of pelvic pain and indicators of peritoneal oxidative stress in women with endometriosis in some studies, there are still conflicting theories about the relationship between serum biomarkers of oxidative stress and endometriosis. With this background in mind, the present study aimed to determine the relationship between serum levels of oxidative stress biomarkers and dysmenorrhea, dyspareunia, and pelvic pain in women with endometriosis who referred to Sarem Fertility & Infertility Research Center in Tehran, Iran in 2017. 
Materials & Methods: This was a descriptive, correlational and cross-sectional study performed on 60 women aged 15-49 years with symptoms of endometriosis. The inclusion criteria were diagnosis of endometriosis based on clinical symptoms and laparoscopy, no current pelvic inflammation disease and adenomyosis, no smoking, or alcohol and drug consumption, no chronic underlying diseases, and no psychological diseases (data were obtained through self-report). Subjects were selected by convenience sampling, and written informed consent was obtained from the participants prior to the study. Data were collected using a demographic characteristics questionnaire, fertility profile questionnaire, endometriosis symptoms checklist, research laboratory information record sheet, and visual analogue scale (VAS) for measuring pain. Following filling out the scales and questionnaires, 10 ccs of the blood sample were taken from each of the volunteers under sterile conditions in citrate tubes and stored after centrifugation at -20°C. Afterwards, blood samples were analyzed, and data analysis was carried out in SPSS version 16 using Pearson’s correlation coefficient. In addition, a P-value of below 0.05 was considered statistically significant. 
Results: The mean age of the participants was 33.16 ± 5.41 years and the mean age of their spouses was 35.96 ± 8.62. Moreover, the subjects had a body mass index (BMI) of 25.92 ± 5.94 kg/m2, and most of them were housewives (68.3%) and had an academic degree (51.7%). Based on VAS score range of 0-100, the mean score of dysmenorrhea in the subjects was reported to be 50.76 ± 32.90, whereas their mean scores of dyspareunia and pelvic pain were 23.70 ± 25.20 and 21.05 ± 23.49, respectively. Furthermore, most of the participants in the study had no history of previous delivery (83.3%) and abortion (75%). Moreover, dysmenorrhea (96.7%), dyspareunia (66.6%) and chronic pelvic pain (73.3%) were reported in most participants. The results of this study showed that women participating in this study had ROS values of 5.77 ± 0.57 micromoles, TAC of 0.35 ± 0.12 micromoles and MDA of 38.06 ± 24.9 micromoles. According to the results, there was a significant relationship between the level of pelvic pain, dysmenorrhea and dyspareunia.
Conclusion: In this study, the majority of the participants suffered from pelvic pain, dysmenorrhea and dyspareunia, which was not unexpected due to the fact that endometriosis is the main factor for these conditions. The high prevalence of these pains has been reported in other studies as well. There is a theory that very small recurrent bleeding in endometriosis lesions and subsequent inflammation may be responsible for menstrual cramps. On the other hand, stretching of the uterosacral ligament, which contains endometriosis tissue, during intercourse, as well as the proximity of nerve fibers to abnormal endometrial tissue, may explain the dyspareunia created in these women. Immune system dysfunction due to endometriosis lesions can be another cause of pelvic pain (e.g., endometriosis), which ultimately leads to neuropathic pains. These patients have also reported pelvic pain caused by tissue degradation induced by immune processes. According to the results, there was no relationship between the severity of dysmenorrhea, dyspareunia, and chronic pelvic pain with the number of reactive oxygen species and the total antioxidant capacity of malondialdehyde in the participants. In a research, Amreen et al. mentioned a significant association between glutathione peroxide levels and dysmenorrhea in women with endometriosis. However, oxidative stress was only slightly exacerbated in the subjects. Moreover, the decrease of antioxidants was insignificant in women with endometriosis and chronic pelvic pain, and even the increase in the concentration of lipid peroxides, which occurs in peritoneal fluid, is not observed in the blood. The results were indicative of no significant relationship between chronic leg pain and dyspareunia with levels of oxidative stress biomarkers. It is generally believed that an increase in oxidative stress of those with dysmenorrhea depends on oxygen-free radicals. However, no studies have clearly mentioned the existence and relationship of oxygen-free radical balance and antioxidant systems with dysmenorrhea. Nonetheless, further studies are required to investigate this issue. It is recommended that oxidative stress biomarkers in peritoneal fluid in women with endometriosis be evaluated in future studies. 
Full-Text [PDF 1048 kb]   (693 Downloads)    
Type of Study: Research | Subject: Midwifery
Received: 2020/07/13 | Accepted: 2020/10/12 | Published: 2020/10/12

1. Shafrir AL, Farland LV, Shah DK, Harris HR, Kvaskoff M, Zondervan K, Missmer SA. Risk for and consequences of endometriosis: a critical epidemiologic review. Best Pract Res Clin Obstet Gynaecol. 2018;51:1-5. [DOI:10.1016/j.bpobgyn.2018.06.001] [PMID]
2. Di Guardo F, Shah M, Cerana MC, Biondi A, Karaman E, Török P, Yela DA, Giampaolino P, Marín-Buck A, Laganà AS. Management of women affected by endometriosis: Are we stepping forward?. J Endometr Pelvic Pain Disord. 2019;11(2):77-84. [DOI:10.1177/2284026519841520]
3. Singh S, Soliman AM, Rahal Y, Robert C, Defoy I, Nisbet P, Leyland N. Prevalence, symptomatic burden, and diagnosis of endometriosis in Canada: cross-sectional survey of 30 000 women. J Obstet Gynaecolo Can. 2020;42(7):829-38. [DOI:10.1016/j.jogc.2019.10.038] [PMID]
4. Ek M, Roth B, Ekström P, Valentin L, Bengtsson M, Ohlsson B. Gastrointestinal symptoms among endometriosis patients-A case-cohort study. BMC women's health. 2015;15(1):1-0. [DOI:10.1186/s12905-015-0213-2] [PMID] [PMCID]
5. Warzecha D, Szymusik I, Wielgos M, Pietrzak B. The Impact of Endometriosis on the Quality of Life and the Incidence of Depression-A Cohort Study. Int J Environm Res Public Health. 2020;17(10):3641. [DOI:10.3390/ijerph17103641] [PMID] [PMCID]
6. Nezhat C, Vang N, Tanaka PP, Nezhat CH. Optimal management of endometriosis and pain. Endomet Adolesc. 2020:195-204. [DOI:10.1007/978-3-030-52984-0_7]
7. Santanam N, Kavtaradze N, Murphy A, Dominguez C, Parthasarathy S. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Transl Res. 2013;161(3):189-95. [DOI:10.1016/j.trsl.2012.05.001] [PMID] [PMCID]
8. Triolo O, Laganà AS, Sturlese E. Chronic pelvic pain in endometriosis: an overview. J Clin Med Res. 2013;5(3):153-63. [DOI:10.4021/jocmr1288w] [PMID] [PMCID]
9. Zubrzycka A, Zubrzycki M, Perdas E, Zubrzycka M. Genetic, epigenetic, and steroidogenic modulation mechanisms in endometriosis. J Clin Medic. 2020;9(5):1309. [DOI:10.3390/jcm9051309] [PMID] [PMCID]
10. Scutiero G, Iannone P, Bernardi G, Bonaccorsi G, Spadaro S, Volta CA, Greco P, Nappi L. Oxidative stress and endometriosis: a systematic review of the literature. Oxidat Medic Cellul Longev. 2017 Oct;2017. [DOI:10.1155/2017/7265238] [PMID] [PMCID]
11. Agarwal A, Gupta S, Sekhon L, Shah R. Redox considerations in female reproductive function and assisted reproduction: from molecular mechanisms to health implications. Antiox Redox Signal. 2008;10(8):1375-404. [DOI:10.1089/ars.2007.1964] [PMID]
12. Bulun SE, Cheng YH, Yin P, Imir G, Utsunomiya H, Attar E, Innes J, Kim JJ. Progesterone resistance in endometriosis: link to failure to metabolize estradiol. Molec Cellular Endocrinol. 2006;248(1-2):94-103. [DOI:10.1016/j.mce.2005.11.041] [PMID]
13. Park YB, Heo GM, Moon HK, Cho SJ, Shin YC, EOM KS, Kim CH, Lee JY, Mo EK, JUNG KS. Pulmonary endometriosis resected by video‐assisted thoracoscopic surgery. Respirology. 2006;11(2):221-3. [DOI:10.1111/j.1440-1843.2006.00829.x] [PMID]
14. Reis FM, Petraglia F, Taylor RN. Endometriosis: hormone regulation and clinical consequences of chemotaxis and apoptosis. Human Reproduc Update. 2013;19(4):406-18. [DOI:10.1093/humupd/dmt010] [PMID] [PMCID]
15. De Ziegler D, Borghese B, Chapron C. Endometriosis and infertility: pathophysiology and management. The Lancet. 2010;376(9742):730-8. [DOI:10.1016/S0140-6736(10)60490-4]
16. Jouhari S, Mohammadzadeh A, Soltanghoraee H, Mohammadi Z, Khazali S, Mirzadegan E, Lakpour N, Fatemi F, Zafardoust S, Mohazzab A, Naderi MM. Effects of silymarin, cabergoline and letrozole on rat model of endometriosis. Taiwanese J Obstetr Gynecol. 2018;57(6):830-5. [DOI:10.1016/j.tjog.2018.10.011] [PMID]
17. Szczepańska M, Koźlik J, Skrzypczak J, Mikołajczyk M. Oxidative stress may be a piece in the endometriosis puzzle. Fertility and sterility. 2003;79(6):1288-93. [DOI:10.1016/S0015-0282(03)00266-8]
18. Baboo KD, Chen ZY, Zhang XM. Role of oxidative stress and antioxidant therapies in endometriosis. Reproduc Developm Medic. 2019;3(3):170-6. [DOI:10.4103/2096-2924.268154]
19. Jackson LW, Schisterman EF, Dey-Rao R, Browne R, Armstrong D. Oxidative stress and endometriosis. . Human Reproduc. 2005;20(7):2014-20. [DOI:10.1093/humrep/dei001] [PMID]
20. Santulli P, Chouzenoux S, Fiorese M, Marcellin L, Lemarechal H, Millischer AE, Batteux F, Borderie D, Chapron C. Protein oxidative stress markers in peritoneal fluids of women with deep infiltrating endometriosis are increased. Human Reproduction. 2015;30(1):49-60. [DOI:10.1093/humrep/deu290] [PMID]
21. Augoulea A, Kindis A, Karopoulou E, Tsoltos N, Kaparos G, Tsakonas E, Panoulis K. Age at Menarche and Oxidative Stress Markers in Women with Endometriosis. SN Comprehensive Clin Medic. 2020;2(1):69-74. [DOI:10.1007/s42399-019-00214-x]
22. Wright KR. The role of oxidation-sensitive nociception and epigenetics in endometriosis-associated pain. Theses ,Dissertations and Capstones. 2017. 1103. http://mds.marshall.edu/etd/1103
23. Nasiri N, Moini A, Eftekhari-Yazdi P, Karimian L, Salman-Yazdi R, Arabipoor A. Oxidative stress statues in serum and follicular fluid of women with endometriosis. Cell Journal (Yakhteh). 2017;18(4):582.
24. Zhang Y, Li-Li MA, Qi-Rong LI. The role of PON-1 and MDA in the serum of patients with endometriosis. Chin J Birth Health Hered. 2009;3:27-8.
25. Park S, Lim W, Bazer FW, Song G. Apigenin induces ROS‐dependent apoptosis and ER stress in human endometriosis cells. J Cellulr Physiol. 2018;233(4):3055-65. [DOI:10.1002/jcp.26054] [PMID]
26. Amreen S, Kumar P, Gupta P, Rao P. Evaluation of oxidative stress and severity of endometriosis. J Human Reprod Sci. 2019;12(1):40-6. [DOI:10.4103/jhrs.JHRS_27_17] [PMID] [PMCID]
27. Polak G, Wertel I, Kozioł-Montewka M, Tarkowski R, Kotarski J. Investigation of glutathione concentrations in peritoneal fluid from women with and without endometriosis. Eur J Obstet Gynecol Reproduc Biol. 2003;109(2):206-8. [DOI:10.1016/S0301-2115(03)00076-9]
28. do Amaral VF, Bydlowski SP, Peranovich TC, Navarro PA, Subbiah MT, Ferriani RA. Lipid peroxidation in the peritoneal fluid of infertile women with peritoneal endometriosis. Eur J Obstet Gynecol Reproduc Biol. 2005;119(1):72-5. [DOI:10.1016/j.ejogrb.2004.07.020] [PMID]
29. Righarts A, Osborne L, Connor J, Gillett W. The prevalence and potential determinants of dysmenorrhoea and other pelvic pain in women: a prospective study. BJOG: Int J Obstet Gynaecol. 2018;125(12):1532-9. [DOI:10.1111/1471-0528.15247] [PMID] [PMCID]
30. Van Langendonckt A, Casanas-Roux F, Donnez J. Oxidative stress and peritoneal endometriosis. Fertil Steril. 2002;77(5):861-70. [DOI:10.1016/S0015-0282(02)02959-X]
31. Agarwal SK, Foster WG, Groessl EJ. Rethinking endometriosis care: applying the chronic care model via a multidisciplinary program for the care of women with endometriosis. Int J Women's Health. 2019;11:405. [DOI:10.2147/IJWH.S207373] [PMID] [PMCID]
32. Evans SF, Brooks TA, Esterman AJ, Hull ML, Rolan PE. The comorbidities of dysmenorrhea: a clinical survey comparing symptom profile in women with and without endometriosis. J Pain Research. 2018;11:3181. [DOI:10.2147/JPR.S179409] [PMID] [PMCID]
33. Schliep KC, Mumford SL, Peterson CM, Chen Z, Johnstone EB, Sharp HT, Stanford JB, Hammoud AO, Sun L, Buck Louis GM. Pain typology and incident endometriosis. Human Reprod. 2015;30(10):2427-38. [DOI:10.1093/humrep/dev147] [PMID] [PMCID]
34. Fauconnier A, Fritel X, Chapron C. Endometriosis and pelvic pain: epidemiological evidence of the relationship and implications. Gynecol Obstet Fertil. 2009;37(1):57-69. [DOI:10.1016/j.gyobfe.2008.08.016] [PMID]
35. Fauconnier A, Chapron C, Dubuisson JB, Vieira M, Dousset B, Bréart G. Relation between pain symptoms and the anatomic location of deep infiltrating endometriosis. Fertil Steril. 2002;78(4):719-26. [DOI:10.1016/S0015-0282(02)03331-9]
36. Tulandi T, Felemban A, Chen MF. Nerve fibers and histopathology of endometriosis-harboring peritoneum. J Am Assoc Gynecol Laparosc. 2001;8(1):95-8. [DOI:10.1016/S1074-3804(05)60556-7]
37. Montoya-Estrada A, Coria-García CF, Cruz-Orozco OP, Aguayo-González P, Torres-Ramos YD, Flores-Herrera H, Hicks JJ, Medina-Navarro R, Guzmán-Grenfell AM. Increased systemic and peritoneal oxidative stress biomarkers in endometriosis are not related to retrograde menstruation. Redox Report. 2019;24(1):51-5. [DOI:10.1080/13510002.2019.1632603] [PMID] [PMCID]
38. Turhan N, Çelik H, Duvan Cİ, Onaran Y, Aydın M, Armutcu F. Investigation of oxidative balance in patients with dysmenorrhea by multiple serum markers. J Turk German Gynecol Assoc. 2012;13(4):233‑6. [DOI:10.5152/jtgga.2012.36] [PMID] [PMCID]
39. Wright KR, Mitchell B, Santanam N. Redox regulation of microRNAs in endometriosis-associated pain. Redox Biology. 2017;12:956-66. [DOI:10.1016/j.redox.2017.04.037] [PMID] [PMCID]

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